Department of Family Therapy Dissertations and Applied Clinical Projects

Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


College of Arts, Humanities and Social Sciences – Department of Family Therapy


Pattica A. Cole

Committee Member

John K. Miller

Committee Member

Christopher F. Burnett


The use of social technologies continues to grow at a rapid pace. Such technologies free individuals to communicate with one another in a multitude of ways without the need to be face-to-face in the same room This study was designed to explore, based on a small sample of case studies, the usefulness of one way that social technology is employed today, collaborative email letter writing (CELW), when used in conjunction with live therapy sessions to counsel a self-injuring population. Currently, most email counseling consists of exchanging communications without live clinical intervention (Heinlein, Welfel, Richmond, & Rack, 2003). While self-injury behavior (SIB) is on the rise (Conterio & Lader, 1998; Zila & Kiselica, 2001), there is little evidence that shows that either traditional or systemic postmodern therapies are useful in treating SIB in adolescents or young adults. Alternative forms of communication, such as letter writing (Freedman & Combs, 1996; White, 1995; White & Epston, 1990), have proven to benefit a variety of clients who have a difficult time expressing emotions in live therapy sessions. However, research studies on CELW as an ongoing therapeutic technique with clients are extremely limited. To address this gap, I conducted a qualitative case study on a small sample of clients in which I explored how CELW could be used with certain clients. Considering the in-depth understanding of the therapeutic participant-observer, therapist CELW, client CELW, and the researcher's experience, I sought to establish the meanings of multiple perspectives for analysis of this underused therapeutic technique. I used a cross-case analysis of three individual cases to provide both an in-depth understanding of the similarities and differences across three case studies, and to understand how clinicians might incorporate this additional resource into their clinical practices.